Better
coverage
starts here
Allstate Health Solutions Essentials PPO $25000 Deductible Plan
The Essentials PPO $25,000 plan offers robust coverage with a clear structure that helps you take control of your healthcare expenses. Once you meet your $25,000 deductible, the plan begins sharing costs for inpatient care, diagnostics, office visits, and urgent care services, all the way up to a $250,000 maximum per coverage period. Families will appreciate that child immunizations are covered in full right away, without waiting for the deductible. While this plan does not include prescription drug coverage, free annual physicals, or preexisting condition benefits, it delivers meaningful protection when you need it most. Backed by the nationwide Aetna PPO network, you’ll have access to top doctors and hospitals across the country, so care is never far away. This plan is a strong choice for those who want reliable coverage for life’s unpredictable moments. You can enhance your coverage with optional Recuro Health benefits, offering $0-copay virtual urgent care, behavioral health, and prescription medications. See the health questions to see if you qualify at <https://www.utahavenue.com/single-post/private-health-plan-qualifications>
Carrier
Allstate
2027
Plan Year
Individual and Family Deductible
An individual deductible and family deductible are key components of a private health insurance plan. The individual deductible represents the amount a single policyholder must pay out of pocket for covered medical expenses before their insurance begins to cover costs. In contrast, a family deductible encompasses the cumulative medical expenses incurred by all covered family members before the insurance kicks in for the rest of the members within the family. Once these deductibles are met, the insurance plan typically covers a percentage of the remaining medical expenses. Maximum out-of-pocket limits are the cap on the total amount a policyholder or family is required to pay in a given year for covered medical services, including deductibles and co-payments. Once this annual limit is reached, the insurance company usually covers all additional eligible expenses, providing financial protection against catastrophic healthcare costs. These components help individuals and families manage healthcare expenses while ensuring they have a safety net against excessive medical bills.
Deductible
$25,000
$75,000
Individual
Family
Maximum Out of Pocket
$32,500
Individual
Family deductible plus $7,500 per member
Family
Coinsurance After Deductible
40% after deductible
Doctor Visits
Knowing what you’ll pay when you visit the doctor is an important part of choosing the right health insurance plan, especially if you or your family regularly use primary care, specialists, or mental health services. Many plans offer a copay, which is a set dollar amount you pay for a covered visit—for example, a $40 copay means you pay $40 for that visit and the insurance company pays the rest. If a service says “after deductible,” it means you generally pay the full negotiated cost of that care until you have met your plan’s deductible, and then the insurance company begins sharing the cost as outlined by the plan. Understanding whether your regular doctor visits have a simple copay or are subject to the deductible can make a big difference in how much you spend on healthcare throughout the year. Below, you can see what this plan charges for some of the most commonly used doctor visits.
Doctor Office Visit
40% after deductible
Specialist Office Visit
Mental Health Visits
$0 copay with optional Recuro Health benefit
Pre-existing Conditions
Not Covered
Emergency and Urgently Needed Services
Knowing the difference between urgent care and the emergency room can help you get the right care while also avoiding unnecessary medical expenses. Urgent care is generally best for medical problems that need attention quickly but are not life-threatening, such as minor injuries, infections, fevers, or illnesses when your regular doctor isn’t available. The emergency room (ER) is designed for serious or potentially life-threatening situations, such as severe injuries, difficulty breathing, chest pain, or other medical emergencies. Your cost for either type of care will depend on your health plan. A copay is a set amount you pay for the visit, for example, a $75 for urgent care or $500 for an ER visit. If the benefit says “after deductible,” you generally pay the plan’s negotiated cost until your deductible has been met, and then your insurance begins sharing the cost according to the plan benefits. Because ER care can be much more expensive than urgent care, understanding these benefits can help you know what to expect when you need care unexpectedly.
Urgent Care Visit
$50 access fee and coinsurance
Emergency Room Visit
$250 access fee, deductible & coinsurance
Ground Ambulance
See full summary of benefits
Coverage Period Maximum
The coverage period maximum is a critical concept in health insurance, representing the utmost limit that a health insurance company will pay for an individual's covered medical services within a specific plan term. This maximum is established to protect both the policyholder and the insurer. Once this limit is reached, the policyholder becomes responsible for all additional medical expenses, unless they renew or enroll in a new insurance plan. Understanding the coverage period maximum is essential for individuals to plan their healthcare expenses effectively, as exceeding this limit can result in substantial out-of-pocket costs. It underscores the importance of selecting a health insurance plan that aligns with one's healthcare needs and financial capacity to ensure comprehensive coverage and peace of mind.
Coverage Maximum
$250,000
Prescription Coverage
Prescription drugs are usually divided into different tiers, and the tier your medication falls into helps determine how much you will pay at the pharmacy. Depending on the health plan, you may see Tier 1 through Tier 4 or 5, or categories such as preferred generic, generic, preferred brand, non-preferred brand, and specialty drugs. Preferred generic medications are typically the lowest-cost option and include many of the common prescriptions people take regularly. Generic drugs may cost a little more, while preferred brand-name drugs are medications the insurance company has negotiated better pricing for. Non-preferred brand drugs generally have higher costs, and specialty medications are usually the most expensive and are often used to treat more complex medical conditions. Below, we show the cost for preferred generic prescriptions, since this is where many commonly used medications fall. If you take a medication in another tier and want to know what it will cost, ask one of our local agents to look it up for you, or you can review the plan’s full Summary of Benefits below for additional prescription cost-sharing information.
Preferred Generic Rx
$0 copay with optional Recuro Health benefit
Extra Benefits for Children
Many health insurance plans include additional dental and vision benefits for children under age 18, helping families manage the cost of important routine care. Depending on the plan, pediatric benefits may include services like dental exams, cleanings, eye exams, glasses, and other covered dental or vision care. The amount the plan pays and your out-of-pocket costs can vary, so it’s important to review the specific benefits of each plan. If the health plan you are considering does not include pediatric dental or vision coverage, ask one of our local Utah Avenue Insurance agents about adding a separate dental or vision plan so your child can have the additional coverage they need.
Children's Immunizations
First dollar benefits
Full Summary of Benefits and Helpful Links
Official plan documents, including the Summary of Benefits and Coverage (SBC) and insurance policy, provide more detailed information about how your health plan works, including deductibles, copays, coinsurance, covered services, and other important benefits. You can also use the provider search links to check which doctors, specialists, hospitals, and other healthcare facilities participate in the plan’s network. We recommend reviewing these resources when comparing plans so you can better understand your coverage, expected costs, and whether the doctors and facilities you prefer are included.
Helpful Links
Schedule a consultation with a local health insurance agent
Insurance doesn’t have to be confusing, and you don’t have to figure it out on your own. Our local Utah Avenue Insurance agents are here to help you compare your options, understand your benefits, and find coverage that fits your healthcare needs and your budget. We can help with Marketplace and private health insurance, Medicare Advantage and Medicare Supplements, dental, vision, life insurance, accident coverage, and more. Meet with us in person, virtually, or over the phone—whatever is easiest for you. Best of all, there is no cost to work with one of our agents, so schedule your consultation today and let us help you find the right coverage with confidence.
The plan benefits, costs, copays, deductibles, networks, and other information shown on this page are provided for general informational purposes and may change. Utah Avenue Insurance makes every effort to provide accurate and up-to-date information; however, the insurance carrier’s official policy documents, Summary of Benefits and Coverage (SBC), and other plan documents will always govern your coverage. Provider networks and prescription drug formularies may also change, so we recommend verifying your doctors, hospitals, and medications before enrolling. If you have questions about a benefit or cost, please contact a Utah Avenue Insurance agent and we’ll be happy to help you review the plan details.